CHILDBIRTH COMPLICATIONS
COMPLICATIONS– ALL LEVELS
1. Meconium
a. Suction the baby's mouth and pharynx extensively before the first breath, preferably on the perineum, prior to delivery. Use a bulb syringe or DeLee suction
b.
2. Nuchal cord (cord is wrapped around the baby's neck)
a. Gently pull and slip over the head or shoulders.
b. Place 2 fingers between cord and infant’s neck
c. If it will not slip over either, clamp cord twice, and cut between clamps and proceed with delivery.
3. Prolapsed cord
a. Place patient in knee-chest position and place 2 fingers in the vagina to support presenting part away from cord until it pulsates.
b. Place a moist sterile dressing over cord
c. Administer oxygen to mother
d. Transport immediately
4. Shoulder dystocia
a. Baby’s shoulder impacts the anterior symphysis pubis and will not deliver. Turtle sign present
b. Position the mother on her left side in a dorsal-knee-chest position to increase the diameter of the pelvis.
c. Attempt to guide the infant's head downward to allow the anterior shoulder to slip under the symphysis pubis. Avoid excessive force or manipulation.
d. Gently rotate the fetal shoulder girdle into the wider oblique pelvic diameter. The posterior shoulder should deliver without resistance.
e. May need to apply posterior pressure just above symphysis pubis to allow shoulder to slip below bony prominence.
5. Vaginal bleeding
a. If just delivered perform fundal message
i. Encourage baby to breast feed
ii. Transport to hospital
b. If not delivered
i. Transport in left lateral recumbent position
ii. If < 20 weeks or unsure if pregnant suspect miscarriage
AEMT
a. Establish IV access and provide NS bolus
PARAMEDIC
a. If the placenta has delivered, and heavy vaginal bleeding continues, administer OXYTOCIN 20 USP units in 500ml Isotonic Solution infuse over 1 hour. This is 83 drops per minute on a 10 drop/ml. IV line.
b. Consider TXA for uncontrolled, non-compressible, postpartum bleeding.
Adult Initial Bolus (16 years and older)
Mix 2 grams in 250 cc bag. Infuse IV/IO over 10 minutes.
COMPLICATIONS– ALL LEVELS
1. Meconium
a. Suction the baby's mouth and pharynx extensively before the first breath, preferably on the perineum, prior to delivery. Use a bulb syringe or DeLee suction
b.
2. Nuchal cord (cord is wrapped around the baby's neck)
a. Gently pull and slip over the head or shoulders.
b. Place 2 fingers between cord and infant’s neck
c. If it will not slip over either, clamp cord twice, and cut between clamps and proceed with delivery.
3. Prolapsed cord
a. Place patient in knee-chest position and place 2 fingers in the vagina to support presenting part away from cord until it pulsates.
b. Place a moist sterile dressing over cord
c. Administer oxygen to mother
d. Transport immediately
4. Shoulder dystocia
a. Baby’s shoulder impacts the anterior symphysis pubis and will not deliver. Turtle sign present
b. Position the mother on her left side in a dorsal-knee-chest position to increase the diameter of the pelvis.
c. Attempt to guide the infant's head downward to allow the anterior shoulder to slip under the symphysis pubis. Avoid excessive force or manipulation.
d. Gently rotate the fetal shoulder girdle into the wider oblique pelvic diameter. The posterior shoulder should deliver without resistance.
e. May need to apply posterior pressure just above symphysis pubis to allow shoulder to slip below bony prominence.
5. Vaginal bleeding
a. If just delivered perform fundal message
i. Encourage baby to breast feed
ii. Transport to hospital
b. If not delivered
i. Transport in left lateral recumbent position
ii. If < 20 weeks or unsure if pregnant suspect miscarriage
AEMT
a. Establish IV access and provide NS bolus
PARAMEDIC
a. If the placenta has delivered, and heavy vaginal bleeding continues, administer OXYTOCIN 20 USP units in 500ml Isotonic Solution infuse over 1 hour. This is 83 drops per minute on a 10 drop/ml. IV line.
b. Consider TXA for uncontrolled, non-compressible, postpartum bleeding.
Adult Initial Bolus (16 years and older)
Mix 2 grams in 250 cc bag. Infuse IV/IO over 10 minutes.